Residents across state mostly see gains in health insurance coverage, with poorest New Jerseyans making significant increases

About 200,000 New Jerseyans gained health insurance in 2014, the first year in which the federal Affordable Care Act affected individuals, according to new estimates released on Thursday by the U.S. Census Bureau.

The annual Small Area Health Insurance Estimates report from census officials shows that the percentage of people in the state lacking health insurance dropped from 15 percent in 2013, which had been the highest point since at least 2008, to 12.6 percent in 2014. That left about 940,000 people uncovered, the first time in seven years that the number of uninsured New Jerseyans dropped below 1 million.

"This is very good news," said Ray Castro, senior policy analyst with New Jersey Policy Perspective. "The marketplace was just starting that year so we expect an even bigger drop in 2015. This shows that the ACA is achieving its most important goal, which is to substantially reduce the number of uninsured."

However, this good news came as a federal district court judge in Washington issued a ruling that sided with Republicans who have sought to overturn the ACA for years and could undermine the law's effectiveness. The judge blocked further federal spending on subsidies to help lower-income people pay for insurance-related expenses, saying Congress never gave its explicit approval for that spending.

The subsidies are one reason advocates say the ACA has been successful in getting so many more Americans on the health insurance rolls.

According to the census data, there was an even more significant increase in insurance coverage among the poorest residents -- those living at no more than twice the federal poverty level. More than three-quarters of people at 200 percent of poverty -- $23,850 for a family of four that year -- had insurance in 2014, up from 70 percent a year earlier. The number of poor people without insurance dropped by 17 percent to about 460,000.

Shivi Prasad of the Legal Services of New Jersey Poverty Research Institute said this is due to the ACA's provision that gave states the option to expand their Medicaid eligibility to most working-age adults living at or below 138 percent of poverty and New Jersey's decision to expand Medicaid to cover these individuals.
"That's one of the big reasons the uninsurance rate declined," she said.

Every New Jersey county saw increases in insurance coverage in their poorest residents and in their total populations.

So did most of the counties across the nation. The census bureau estimated that the uninsured rate for all people under age 65 dropped in nearly three-quarters of the counties from 2013 to 2014 and only one county in the entire United States experienced an increase in its uninsured rate.
In states that expanded Medicaid eligibility, 96 percent of counties had a decrease in uninsured rates for working-age adults, said census officials. In comparison, among the states that did not expand their Medicaid eligibility, 37 percent of counties had a decrease in uninsured rates for their working-age adults.

Prasad said Legal Services' 2015 Poverty Benchmarks report had noted increases in health insurance, but also warned that some of the gains could be short-lived, since some of the newly covered "are already dropping out of ACA-enabled coverage because of inability to pay premiums combined with difficulties in obtaining subsidies and the subsidies being inadequate in amount."